Wonder and other things

I had these moments during first year where I’d be walking down the street in my city thinking about nerves (I’m a med student, ok? I nerd out more than the average person).  Then I’d think about the person I was dating, or my friends, or something else fun and realize that everything we are and feel and do is simply due to ion concentrations and electricity and chemical gradients, receptors, genes, proteins, pathways… and then I’d have a little mind explosion, “OMG that is SO AMAZING!” How beautiful and poetic is it that love equals ion gradients in my brain!  I wasn’t simplifying love or anything else, but I would appreciate the very small in the very complex.

I don’t really have those moments anymore. Or I haven’t for a while. My brain has been too busy with class, studying, othermedschoolnecessities, bills, errands, relationships, eating, fillingbasicneeds and passingexams.

Except, recently, I did have a moment like that – about blood. Holycrap, it works! Your blood carries necessary molecules to your tissues and remains fluid in your arteries and veins. You don’t bleed all over when you get a cut* and your blood doesn’t become a solid mass and cause you to become blue and dead**. That’s amazing! Of course, there are plenty of things that can go wrong and I get to learn all about that fun stuff, but for the most part – it works! It has worked as long as we’ve⁺ had circulatory systems.  Holywow.

Ok, nerdoutexcitement over. Back to the library. 

*Unless you have a bleeding disorder

**Unless you have a coagulopathy

⁺We as in our evolutionary ancestors

Check up

It was just routine. I want to run more and my asthma is preventing me, and the last doctor wasn’t so helpful.  I’ve mentioned before not wanting to be a patient, but I don’t mind going to the PCP.  It was a good reminder of the patient experience. That patients come in with a narrative in mind, things they want to say to their doctor and have their doctor care about (“I’ve never run more than a mile and I want to run 5Ks, isn’t that great?!”).  She went beyond what I came in for and asked about my history in the computer, asked if I had any other questions or concerns, she was good.

The importance of physical exam is interesting. There are a lot of interesting, important things you can pick up on physical exam – but the chances of finding something on an overall healthy person are slim. It is, however, important to the doctor-patient relationship. I knew she wasn’t going to hear me wheeze when she listened to my lungs or find a goiter when she palpated my thyroid, but it still felt reassuring to have my doctor lay her hands on me and check me out.  Isn’t that interesting?

Wednesday Dinners

We were talking about androgen insensitivity disorder, you know, like you do when you're in med school.* 

Friend 1: "Do they have a cervix?"

Friend 2: "No, I think the vagina just ends in a blind pouch. But I'm almost certain the Bartholin's glands are there."

Friend 3: "Well, the vagina's still good for things vaginas are used for."

Friend 2: "Yeah, you can still hide drugs in there."

I love my friends. I really really love them. 

*If you're offened: #1 tough. #2 my friends and I are extremely gay/intersex/trans friendly, so get over it, this is just what med students talk about sometimes.

Uvi-what?

Med school is an exercise in being humble. Most of us have been the best at many things before now. We’ve been in the top of our classes and the leaders of many organizations. We’re used to being smarty-pants-know-it-alls. Not anymore. I’m completely comfortable not being one of the smartest, highest achieving people in my class. I’m surrounded by extremely smart people and the fact that I made it here is enough for me – most of the time.

I’ve mostly gotten over that feeling of, “wow, I didn’t know that, how could I not know that, I must be the dumbest person in med school, they’re going to find out and kick me out.”  Usually, I embrace the fact that it’s all about learning, and if I already knew this stuff, I wouldn’t need to be here.

But sometimes, I still feel dumb.  They throw so many new words at us without explanation, and usually I look them up (on Wikipedia of course), but sometimes I just make erroneous assumptions about what they mean even when it doesn’t make any sense. For example, I thought uveitis was inflammation of the uvula until yesterday. This doesn’t especially make a lot of sense, except that words sound similar – which means nothing in medicine.  I only made the connection yesterday because a professor was naming the symptoms of sarcoidosis and pointed to eyeballs when he said “uveitis.*” So I looked it up later and felt a bit dumb.

I can just imagine having a conversation like this next year with an attending:

“What’s a symptom of Sarcoidosis?”

“Inflammation of the uvula.”

“Sorry, what?”

*Uveitis is inflammation of the middle layer of the eye, the “uvea,” but may refer to anything in the interior of the eye. Thank you Wikipedia.

You should go to the doctor

I identified so strongly with her, which is odd because I don’t have a chronic illness.  It was amazing that a fellow med student would get up there, in front of all of us (in our white coats), and tell us about being a patient. Doctors are not good at being patients. Neither are med students. We are not so good at taking care of ourselves.  Just look here, here, and here.  These example focus mostly on mental health*, but there are plenty of examples of doctors as terrible patients with other diseases like cancer, heart disease, and diabetes.

The class was clearly more interested in asking about this patient/student’s (PS) experience than other patients we’d seen. 

“Has your [illness] affected your career path at all?”

“Um, well I’m going into [a specialty that deals with this illness]”

“When you become a [specialist], do you think you’ll just be your own doctor?”

 The professor cut in here and said sternly, “You should never be your own doctor,” and PS agreed. The student who had asked retorted, “Yeah, but how realistic is that?”

We could taste it – the distain for being a patient. We could feel the desire to control and manage our own disease – imagining ourselves up there.

We also wanted to know how she managed rotations and her chronic illness. Turns out she didn’t control it as well as she would have if she were not in medical school with long days. Wow – what a healthy environment.

PS admitted she didn’t go for her yearly visits to certain specialists, claiming that since she’s had her illness for so long, she knew when something changed. But she’d also admitted that her prodrome to medical crises diminished over the years. And how many of us haven’t noticed subtle changes in our bodies right away?

So why did I identify with her? I could imagine myself up there, saying the same things, ignoring the same guidelines I would use to treat patients.  How many times have I already told my friends, “go to the doctor, go to the doctor” (after asking them a bunch of questions, of course), while putting off my own appointments?  Part of it is that managing anything other than school has gotten increasingly difficult. This includes bills, laundry, doctors’ appointments, cooking food, maintaining friendships**, etc. Another part of it is a refusal to be sick. I don’t have time to be sick (who does, why I am any different?). Another part is that barrier that’s gone up between us (medical professionals) and them (patients). This barrier is necessary in order to do our jobs effectively. It’s a fine line, however. Make that barrier too high and you’ll forget the “them” on the other side are human beings with complex lives, not just complex chemical processes. Don’t build that barrier and you’ll bleed too much for each and every patient and you’ll burn out. 

Also – I know how easily errors can happen, I know how scary hospitals really are. I. Never. Want. To. Be. A. Patient.

*mental health is another topic, and I’m luckily fairily happy as far as med students go.

**I’m pretty good at this, I work hard to take the time to foster my relationships

Politics and Gossip

I’m a part of a big-name organization (BNO) at my school. We were selecting the new members a couple weeks ago, and politics came into play – of course. Of course?

I worked in a hospital before medical school and I was shocked when I figured out there were politics between departments. There was some holiday lunch, and some friends in the same position as I, in a different department, invited us. A couple of us in my department went cheerfully.  When we were pulled aside by some supervisor in their department and reprimanded for eating their (plentiful) food, I was floored. I told my supervisor about it, and she said, “Yeah, that’s why I didn’t go.” Wow, thanks for letting us know… oh wait, no – just throw us to the wolves. Aren’t we all in this for the same thing – better patient care? Why are we fighting about… food? About territory? About departmental identification? About I-don’t-know-what?

Oh, silly-fresh-out-college-me.

I learned politics are a part of every workplace. Sometimes it’s inappropriate and unprofessional.  Sometimes, connections can help you get your foot in the door – but you need to make it to the next step on merit.  No one wants to take unqualified Sue just because so-and-so knows unqualified Sue.  Right?

Med school, for the most part, is filled with extremely professional people. There’s the occasional whiner who talks back to a professor after an exam about an “unfair question,” or the professor who makes some off-color joke, but this is MEDICAL SCHOOL. It’s serious.

I had friends applying for BNO, so did everyone else in BNO. “Check out so-and-so’s interview, I think s/he’d be great.”  These comments gave the rest of us full disclosure and fit into my “connections help you get in the door and get noticed” category. But then – you do how you do in the interview. If you rock it – great – if not, too bad. It was horrifying to me then, when someone who had a terrible interview (that I did not see) got into BNO because of connections (that I do not know) due to conversations (that I did not hear) after the rest of the BNO members had left.

This brings me to my next topic – gossip. I learn a lot about my classmates through gossip. I love hearing gossip. I don’t love sharing gossip. I like to know. People are interesting. Gossip, I realize, has a huge potential to damage people, especially in a professional setting like medical school which is career-centric. So I have my sources I trust, and the few people – mostly unconnected to school – who I trust to talk to. Does this make me a bad person? Unprofessional? It certainly doesn’t make me unique.  It’s not like I would ever act, professionally, on gossip. I can’t do anything about BNO since all I know is by hearsay. I might choose not to be besties with the people involved with what I think is a scandal, but I’ll always be professional with them.

What do you think? What are your stories about politics and gossip in professional settings?

Public Service Announcement

School has been beating me over the head with 4 lectures/day, so instead of write something, I wanted to share this service announcement, as Valentine's Day is coming up:

Things I learn in medical school:

#1 cats have two thyroids
#2 shrinking is not a normal phenomenon

#3 cats have a spiral esophagus

O0wowkthx